Showing papers in "Journal of cardiovascular and thoracic research in 2014"

The predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications after STEMI.

Abstract: Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI) The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical eventsMethods: In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied The complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset of symptoms Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analysesResults: In-hospital mortality and post-STEMI complication rate were 37% and 436%, respectively Higher age (P=004), female gender (0002), lower ejection fraction (P<0001) and absolute neutrophil count (P=004) were predictors of mortality Pump failure in the form of acute pulmonary edema or cardiogenic shock occurred in 35 (89%) of patients Higher leukocyte (P<003) and neutrophil counts (P<003) and higher NLR (P=001) were predictors of failure The frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher neutrophil count (P<0001) and higher NLR level (P<0001) In multivariate analysis neutrophil count was an independent predictor of mortality (OR=294; 11-84, P=004), and neutrophil count [OR=11, CI (101-120), P=002], female gender [OR=234, CI (102-488), P=004] and diabetes [OR=252, CI (121-52), P=0003] were independent predictors of heart failureConclusion: A single CBC analysis may help to identify STEMI patients at risk for mortality and heart failure, and total neutrophil count is the most valuable in predicting both

Vocal cord paralysis and its etiologies: a prospective study.

Abstract: Introduction: Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis.Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such as examination of the pharynx, larynx, esophagus, thyroid, cervical, lung, and mediastinum, brain and heart by diagnostic imaging to investigate the cause vocal cord paralysis. The study was ended by diagnosing the reason of vocal cord paralysis at each stage of the examination and the clinical studies.Results: The mean duration of symptoms was 18.95±6.50 months. The reason for referral was phonation changes (97.8%) and aspiration (37.8%) in the subjects. There was bilateral paralysis in 6.82%, left paralysis in 56.82% and right in 63.36% of subjects. The type of vocal cord placement was midline in 52.8%, paramedian in 44.4% and lateral in 2.8% of the subjects. The causes of vocal cords paralysis were idiopathic paralysis (31.11%), tumors (31.11%), surgery (28.89%), trauma, brain problems, systemic disease and other causes (2.2%).Conclusion: An integrated diagnostic and treatment program is necessary for patients with vocal cord paralysis. Possibility of malignancy should be excluded before marking idiopathic reason to vocal cord paralysis.

Predictors of Prolonged Mechanical Ventilation after Open Heart Surgery

Abstract: Introduction: Due to the importance of prolonged mechanical ventilation (PMV) as a postoperative complication, predicting "high-risk" patients by identifying predisposing risk factors is of important issue. The present study was aimed to identify perioperative variables associated with PMV in patients undergoing open heart surgery.Methods: A total of 743 consecutive patients, American Society of Anesthesiologists (ASA)physical status class III, who were scheduled to undergo open heart surgery using cardiopulmonary bypass were included in this observational study. Perioperative variables were compared between the patients with and without PMV, as defined by an extubation time of >48 h.Results: PMV occurred in 45 (6.1%) patients. On univariate analysis, pre-operative variables;including gender, history of chronic obstructive pulmonary disease (COPD); chronic kidney disease and endocarditis, intra-operative variables; including type of surgery, operation time,pump time, transfusion in operating room and postoperative variables; including bleeding andinotrope-dependency were significantly different between patients with and without PMV (all P<0.001, except for COPD and transfusion in operating room; P=0.004 and P=0.017, respectively).Conclusion: Our findings reinforce that risk stratification for predicting delayed extubation should be an important aspect of preoperative clinical evaluation in all anesthesiology settings.

Main complications of mild induced hypothermia after cardiac arrest: a review article.

Abstract: The aim of the present study is to assess the complications of mild induced hypothermia (MIH) in patients with cardiac arrest. Presently, based on the guidelines of the American heart Association, MIH following successful cardiopulmonary resuscitation (CPR) in unconscious adult patients due to ventricular fibrillation (VF) with out-of-hospital cardiac arrest (OOHCA) is essential and required. However, MIH could be associated with complications in Patients with cardiac arrest. Studies conducted on the precautions and care following cardiac arrest and MIH were included. Valid scientific data bases were used for data collection. The obtained results from different studies revealed that mild MIH could be associated with numerous complications and the knowledge and awareness of the medical staff from the complications is required to guarantee successful therapeutic approaches in MIH following cardiac arrest which is a novel medical facility with different styles and complications. Overall, further future studies are required to improve the quality of MIH, to increase survival and to decrease complications rates.

A Review of Current Analgesic Techniques in Cardiac Surgery. Is Epidural Worth it

Abstract: In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers.

Laryngeal Ultrasonography Versus Cuff Leak Test in Predicting Postextubation Stridor

Abstract: Introduction: Although cuff leak test has been proposed as a simple method of predicting the occurrence of postextubation stridor, cut-off point of cuff-leak volume substantially differs between previous studies. In addition, laryngeal ultrasonography including measurement of air column width could predict postextubation stridor. The aim of the present study was to evaluate the value of laryngeal ultrasonography versus cuff leak test in predicting postextubation stridor.Methods: In a prospective study, all patients intubated for a minimum of 24 h for acute respiratory failure, airway protection and other causes were included. Patients were evaluated for postextubation stridor and need for reintubation after extubation. The cuff leak volume was defined as a difference between expiratory tidal volumes with the cuff inflated and deflated. Laryngeal air column width was defined as the width of air passed through the vocal cords as determined by laryngeal ultrasonography. The air-column width difference was the width difference between balloon-cuff inflation and deflation.Results: Forty one intubated patients with the mean age of 57.16±20.07 years were included. Postextubation stridor was observed in 4 patients (9.75%). Cuff leak test (cut off point: 249 mL) showed sensitivity and specificity of 75% and 59%, respectively. In addition, laryngeal ultrasonography (cut off point for air column width: 10.95 mm) resulted in sensitivity and specificity of 50% and 54%, respectively. Positive predictive value of both methods were <20%.Conclusion: Both cuff leak test and laryngeal ultrasonography have low positive predictive value and sensitivity in predicting postextubation stridor and should be used with caution in this regard.

Cardiovascular Risk Factors in Young Patients of Coronary Artery Disease: Differences over a Decade.

Abstract: Introduction: Studies evaluating temporal trends of Coronary artery disease (CAD) in youngpatients, from the India, are still lacking. The aim of this study was to evaluate temporal differencesin risk factors of young patients of CAD over a decade.Methods: This is a single centre retrospective study performed in a tertiary care teaching institutionin North India. Case records of young patients (≤40 years) with acute coronary syndrome betweenJanuary 2000 to December 2001 and January 2009 to December 2010 were obtained. Recordswere sought for active smoking, family history, waist size, blood pressure, hypertension, fastingand postprandial blood sugar and lipid profile for both groups and analyzed using SPSS v.17. Forthe purpose of the study, p value <0.05 was considered statistically significant.Results: Medical records of a total of 79 and 83 patients with young CAD (≤ 40 years) wereobtained for 2000-01 and 2009-10 period respectively. An increase in proportion of femalepatients, hypertension (p=0.004), dysglycemia (p<0.001), family history (p=0.01), metabolicsyndrome (p<0.001), low high density lipoprotein (HDL) (p=0.07) and mean waist size (0.03)was noted over the years. Among males, increase in number of dysglycemics (p=0.0002), positivefamily history (p<0.0001) and mean waist size (0.032) was statistically significant.Conclusion: Over a decade the patients with young CAD in our study, there was an increase inproportion of patients with metabolic syndrome, dysglycemia and low HDL.

Epicardial and pericardial fat volume correlate with the severity of coronary artery stenosis.

Abstract: Introduction: Epicardial fat volume (EFV) has been reported to correlate with the severity of coronary artery disease (CAD). Pericardial fat volume (PFV) has recently been reported to be strongly associated with CAD severity and presence. We aimed to investigate the relationship between EFV and PFV with severity of coronary artery stenosis in patients undergoing 64-slice multi-slice computed tomography (MSCT). Methods: One hundred and fifty one patients undergoing MSCT for suspected CAD were enrolled. Non-enhanced images were acquired to assess calcium score. Contrast enhanced images were used to quantify EFV, PFV and severity of luminal stenosis. Results: Coronary artery stenosis was mild in 25 cases (16.6%), moderate in 58 cases (38.4%) and severe in 68 cases (45%). With increase in severity of coronary artery stenosis, there was significant increase in PFV, EFV as well as epicardial fat thickness in right ventricle free wall in basal view and epicardial fat thickness in left ventricle posterior wall in mid and apical view. There was significant linear correlation between PFV with coronary calcification score (r=0.18, P=0.02), between coronary artery stenosis severity and PFV (r=0.75, P<0.001), EFV (r=0.79, P<0.001), apical epicardial fat thickness in right ventricle free wall (r=0.29, P<0.001), Mid (r=0.28, P<0.001) and basal (r=0.23, P=0.004) epicardial fat thickness in left ventricle posterior wall. Conclusion: PFV, EFV and regional epicardial thickness are correlated with severity of CAD and could be used as a reliable marker in predicting CAD severity.

Predisposing factors to premature coronary artery disease in young (age ≤ 45 years) smokers: a single center retrospective case control study from India.

Abstract: Introduction: The role of the conventional risk factors in premature coronary artery disease (CAD) after eliminating the confounding variability of smoking has not been evaluated. This study was conducted to identify role of traditional risk factors in smokers with premature CAD.Methods: The case records of patients presenting acutely with premature CAD during the period 2007-2010 were analyzed retrospectively. Age, sex and smoking matched controls were selected from same time period. Data records were obtained for family history, alcohol, waist size, blood pressure, hypertension, blood sugar, lipid profile and presence of cutaneous markers for both groups and analyzed using statistical software.Results: 234 smokers with CAD and 122 smokers without CAD were included in groups 1 and 2, respectively. The patients in group 1 had significantly increased prevalence of hypertension, diabetes mellitus, metabolic syndrome, dyslipidemia and central obesity. There was no difference in prevalence of family history of CAD, arcus juvenilis and baldness. We found statistically significant association of hypertension, DM and metabolic syndrome in young smokers with premature acute CAD in Indian population as compared to young smokers without CAD.Conclusion: In young smokers, presence of hypertension, central obesity, diabetes mellitus and metabolic syndrome identifies a subset at increased risk for future acute CAD requiring more rigorous follow up and treatment.

High Creatine Kinase (CK)-MB and Lactate Dehydrogenase in the Absence of Myocardial Injury or Infarction: A Case Report.

Abstract: Acute myocardial infarction (AMI) is a life threatening condition that needs emergency diagnosis and early treatment in the emergency room. Rapid laboratory testing for creatine kinase (CK)-MB greatly revolutionized the diagnosis and management of acute myocardial infarction. We report a case with chest pain that referred to the emergency department (ED). Laboratory data showed high serum levels of creatine kinase and lactate dehydrogenase. With diagnosis of acute myocardial infarction, he was hospitalized and angiography was performed which showed three vessels disease; the patient was referred to surgical ward for coronary artery bypass graft. Surgery was performed after one week; during the operation there was no sign of infarction over the heart. Our observation suggests that false positive laboratory result may be due to other condition which must be evaluated.

Body Mass Index or Serum Albumin Levels: Which is further Prognostic following Cardiac Surgery?

Abstract: Introduction: Patients with low serum albumin and abnormal BMI may be at the risk of death and other complications after surgery. This could be remarkable in patients with coronary arteries bypass graft surgery. Therefore, we decided to evaluate the impact of these factors associated with survival and outcome after cardiac surgery.Methods: A cross-sectional study was performed from 2009 until 2012 on 345 patients who underwent coronary artery bypass grafts. Also Patients were monitored for a year. Patients’ information was collected and then the patients were analyzed for body mass index (BMI) and serum albumin and their effects on postoperative outcomes. P value 30). Obese patients are more susceptible to myocardial infarction in postoperative period (P=0.02). Pneumonia after surgery in these patients was more common than others (P= 0.023); however, low serum albumin was significantly associated with mortality following operation (P<0.001). Reoperation due to bleeding (P<0.001) and required mechanical ventilation for more than a day (P=0.019) were significantly associated with low serum albumin.Conclusion: In conclusion, the high or low BMI alone did not increase mortality after cardiac surgery. However, postoperative morbidity in obese patients may be greater than others. Low serum albumin may increase the risk of mortality and postoperative complications as well. Therefore, it seems ameliorating serum albumin can be effective more than body mass index in improving the outcome of patients after CABG surgery.

Serum uric Acid predicts declining of circulating proangiogenic mononuclear progenitor cells in chronic heart failure patients.

Abstract: Introduction: Serum uric acid (SUA) is considered a marker for natural progression of chronic heart failure (CHF) mediated cardiovascular remodelling. CHF associates with declining of circulating mononuclear progenitor cells (MPCs). The objective of this study was to evaluate the interrelationship between SUA concentrations and proangiogenic MPCs in ischemic CHF patients. Methods: The study population was structured retrospectively after determining the coronary artery disease (CAD) by contrast-enhanced spiral computed tomography angiography in 126 subjects with symptomatic ischemic mild-to-severe CHF and 128 CAD subjects without CHF. Baseline biomarkers were measured in all patients. Cox proportional multivariate hazard ratio was calculated for predictors of MPCs declining in both CHF and non-CHF patient population predictors of MPCs declining in CHF subjects were examined in stepwise logistic regression. C-statistics, integrated discrimination indices (IDI) and net-reclassification improvement were utilized for prediction performance analyses. Results: Cox proportional adjusted hazard ratio analyses for CD14+CD309+ and CD14+CD309+Tie2+ MPCs by SUA has shown that the higher quartiles (Q3 and Q4) of SUA compared to the lower quartiles (Q1 and Q2) are associated with increased risks of depletion of both CD14+CD309+ and CD14+CD309+Tie2+ MPCs. The addition of Q4 SUA to the ABC model improved the relative IDI by 13.8% for depletion of CD14+CD309+ MPCs and by 14.5% for depletion of CD14+CD309+Tie2+ MPCs. Conclusion: Circulating levels of proangiogenic MPCs are declined progressively depending on the levels of SUA in the HF subjects with CHF. We suggest that even mild elevations of SUA might be used to predict of relative depletion of proangiogenic MPCs among chronic HF patients.

Non-modifiable Factors of Coronary Artery Stenosis in Late Onset Patients with Coronary Artery Disease in Southern Iranian Population

Abstract: Introduction: Coronary Artery disease (CAD) is influenced by genetic factors, environment and culture behavior. The aim of the present study was to evaluate some non-modifiable risk factors of coronary heart disease such as sex, age, family history and consanguineous marriage. Methods: This is a case-control study. The study population consisted of 200 fifteen or more years old. Data were collected on 200 patients with positive angiography and 200 control subjects with negative angiography. Positive angiography was defined as coronary diameter cut greater than 50%. Statistical analysis was conducted using SPSS 11.5. In this study, data were collected through a checklist. Logistic regression and stratification were used to determine the impact of age, gender, family history, and consanguinity on the risk of stenosis. Results: The percentage of men in patients and controls were 89% and 29%, respectively. As to gender, a significant association was found between patients and controls of CAD (CI 95%, 4.014-10.052, OR 6.352). Gender was determined as a risk factor for CAD. Family history of myocardial infarction did not show a significant effect on the artery stenosis. As to consanguinity of the parents, there was no significant association between patients and controls of CAD (P> 0.05). Conclusion: These researches show that ageing increases the risk of coronary heart stenosis; also, females are more than men protected against this disease. The impact of family history of myocardial infarction and consanguineous marriage were not associated with of CAD.

The Impact of Stress Hormones on Post-traumatic Stress Disorders Symptoms and Memory in Cardiac Surgery Patients

Abstract: The relationship and interactions between stress hormones and post-traumatic stress disorder (PTSD) are well established from both animal and human research studies. This interaction is especially important in the post-operative phase of cardiac surgery where the development of PTSD symptoms will result in increased morbidity and mortality and prolong length of stay for critically ill cardiac surgery patients. Cardiopulmonary bypass itself will independently result in massive inflammation response and release of stress hormones in the perioperative period. Glucocorticoid may reduce this response and result in reduction of PTSD symptom clusters and therefore improve health outcome. In this review, we plan to conduct a systemic review and analysis of the literatures on this topic.

Transcatheter Versus Surgical Closure of Atrial Septum Defect: A Debate from a Developing Country

Abstract: Introduction: This study compares the effectiveness and cost of trans-catheter verses surgicalclosure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiacdefects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention.Surgical repair is advised in a proportion of secundum type defects which are unsuitable fordevice closure.Methods: We reviewed the clinical course of 176 patients who underwent closure of isolatedsecundum ASD. The patients were assigned to either the device or surgical group depending uponthe treatment they received. Successful closure was assessed immediately after the procedure. Thefollowing outcomes were studied: mortality, morbidity, hospital stay, and costs.Results: Ninety five patients were in the surgical group and 81 patients were in the groupundergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical groupand 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. Theprocedure success rate was 100% for the surgical group and 96.3% for the device group. Thecomplication rate was 13.7% for surgical group and 7.4% for the device group. The mean lengthof hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. Theprocedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure.Conclusion: Successful closure is achieved by both methods. Trans-catheter closure results inlower rate of complication and hospital stay but the cost of the procedure tends to be higherthan surgery.

Comparison of the Complications between Left Side and Right Side Subclavian Vein Catheter Placement in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Abstract: Introduction: Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients who undergo coronary artery bypass graft (CABG) surgery.Methods: This prospective, randomized clinical trial was performed in193 patients. The technique applied for cannulation was infraclavicular approach for both the right and the left sides. Subclavian vein of other side was attempted only when catheterization at initial side was unsuccessful at two attempts. The success and complication rates were compared for the two sides.Results: On193 patients, catheterization attempts were performed. 177 catheterizations (91.7%) were successful during the first attempt, 105 (92.1%) on the right side and 72 (91.1%) on the left side. There was no significant difference between success rate and side of catheterization. Malposition of the catheter tip on the right side (9.6%) was significantly more than the left side (0%) (P= 0.003). The differences in other complications on two sides were statistically insignificant.Conclusion: Compared with the right side, insertion of the cannula on the left side resulted in fewer catheter tip misplacements. Incidence of cannulation failure and other complications were similar on both sides.

Effect of peripheral edema on oscillometric blood pressure measurement.

Abstract: Introduction: Blood pressure( BP )measurement is essential for epidemiological studies and clinical decisions . It seems that tissue characters can effect on BP resultso and we try to find edema effect on BP measured by three methods of oscillometric , auscultation and arterial . Method and materials: Blood pressure of 55 children candidated for open heart surgery were measured and compared with three methods : Arterial as standard and reference ,oscillometric and auscultatory . Peripheral edema as an tissue character which defined as higher than +2 as marked edema and equal or lower than +2 considered as no edema . statistical method :Data expressed by Mean (95% of confidence interval(CI 95%). Comparison between two group was done by T independent test and ANOVA test for more than two groups. Mann whitney U and paired T test test used for serially comparisons of methods . P less than 0.05 is significant. Results: 55 children aged 29.4±3.9 months ,they divided to two groups 10 children with peripheral edema beyond 2+ and 45 cases without edema. Oscillometric method overestimate systolic BP the Mean (CI 95%) difference of arterial to oscillomeric was 4.8(8/-1 , p 0.02) in edematous and 4.2(7/1 p 0.004) in non edematous. In diastolic BP oscillometric method underestimate -9(-1.8/-16.5, p0.03) in edematous group and 2.6(-0.7/+5,p 0.2) in non edematous. Conclusion : Oscillometric device standards can not cover all special clinical conditions and age groups .It underestimate diastolic BP significantly in edematous children, it was 9.2 mmHg in average as our study.

Mid-term outcome of mechanical pulmonary valve prostheses: the importance of anticoagulation.

Abstract: Introduction: Pulmonary valve replacement (PVR) is being performed more commonly lateafter the correction of tetralogy of Fallot. Most valves are replaced with an allograft or xenograft,although reoperations are a common theme. Mechanical prostheses have a less favorable reputationdue to the necessity of lifelong anticoagulation therapy and higher risk of thrombosis, but they arealso less likely to require reoperation. There is a paucity of data on the use of prosthetic valves inthe pulmonary position. We report the midterm outcomes of 38 cases of PVR with mechanicalprostheses.Methods: 122 patients who underwent PVR were studied. Thirty-eight patients, mean age 25 ±8.4 years underwent PVR with mechanical prostheses based on the right ventricular functionand the preferences of the patients and physicians. Median age of prosthesis was 1 year (range 3months to 5 years).Results: Seven (18%) patients had malfunctioning pulmonary prostheses and two patientsunderwent redo PVR. Mean International Normalized Ratio (INR) in these seven patientswas 2.1±0.8. Fibrinolytic therapy was tried and five of them responded to it well. There wasno significant association between the severity of right ventricular dysfunction, patient’s age,prostheses valve size and age of the prosthesis in the patients with prosthesis malfunction.Conclusion: PVR with mechanical prostheses can be performed with promising midtermoutcomes. Thrombosis on mechanical pulmonary valve prostheses remains a seriouscomplication, but most prosthesis malfunction respond to fibrinolytic therapy, underscoring theneed for adequate anticoagulation therapy.

Difference between Outcome of Left Circumflex Artery and Right Coronary Artery Related Acute Inferior Wall Myocardial Infarction in Patients Undergoing Adjunctive Angioplasty after Fibrinolysis.

Abstract: Introduction: Prognostic differences between anterior and inferior wall Myocardial Infarction (MI) has been extensively investigated, but there is limited information about similar comparison between inferior wall MI caused by right coronary artery (RCA) and left circumflex artery (LCX) occlusion. The aim of present study was to compare prognostic differences between LCX- and RCA-related acute inferior wall ST-segment elevation MI (STEMI) treated by routine adjunctive angioplasty after receiving thrombolytic therapy (TLT).Methods: Between March 2012 and June 2013 one hundred fifty consecutive patients with acute inferior wall STEMI were studied. Patients were divided into two groups according to the infarct related artery (LCX vs. RCA). All patients underwent routine adjunctive angioplasty after TLT during the index hospitalization and clinical characteristics and outcomes were compared.Results: RCA and LCX arteries were occluded in 97 (64.7%) and 53 (35.3%) of patients, respectively. Two groups were similar in baseline characteristics except multiple-vessel disease was more prevalent with LCX occlusion (p= 0.008). There was a higher cardiac enzyme release (p< 0.001), more significant mitral regurgitation (MR) (p= 0.015), and lower left ventricular ejection fraction (LVEF) (p= 0.01) in patients with LCX occlusion. Multivariate analysis showed cTn-I release, occurrence of MR, and lower LVEF as independent factors leading to poor outcome.Conclusions: There were higher cTn-I release, MR occurrence, and lower LVEF in LCX-related acute inferior wall STEMI, all associated with poor outcome. Therefore, patients with ECG finding in favour of LCX occlusion should be considered as high risk and an invasive approach should be planned.

Experiences in surgical closure of atrial septal defect with anterior mini-thoracotomy approach.

Abstract: Introduction: The surgeons and their patients are now seeing the benefits and extendedpossibilities of minimally invasive cardiac surgery. Anterior mini-thoracotomy approach is agood alternative to median sternotomy since it reduces operative trauma, accelerates recoveryand yields a better cosmetic outcome. Our purpose is to explain the details of our technique andmanifest the experience results.Methods: Seventy five patients with secundum Atrial Septal Defect (ASD) (52 female and 23 male)were operated with anterior mini-thoracotomy approach in our tertiary research center betweenMarch 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes weredefined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time,morbidity, mortality, the size of incision, the amount of post-operative bleeding, the amount ofblood transfusion, reoperation and the surgical details.Results: Mean Cardiopulmonary bypass time (CPB time) was 49.62 minutes (from 26 to 105minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (between 11 to 47 minutes).The mean amount of blood transfusion was 47.49± 62.22 mm (ranged 0 to 200 cc) and themean chest tube drainage after surgery was 80.17 ±121.06 mm (ranged 0 to 600 cc). One patientre-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgicalbleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type ASD,in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.Conclusion: Anterior thoracotomy approach is safe and may be the surgical technique ofchoice for secundum ASD repair in all age groups and we can utilize this technique also formore complicated kinds of surgery for instance, sinus venosus type ASD with or without PartialAnomalous Defect.

Effects of music on cardiovascular responses in men with essential hypertension compared with healthy men based on introversion and extraversion.

Abstract: Introduction: The present research investigated the effects of two different types of music on cardiovascular responses in essential hypertensive men in comparison with healthy men based on introversion and extraversion. Methods: One hundred and thirteen hypertensive men referred to Madani Heart Hospital in Tabriz completed the NEO-FFI Questionnaire and after obtaining acceptable scores were classified in four groups: introvert patients, extravert patients, introvert healthy subjects, and extravert healthy subjects (each group with 25 samples with age range 31-50). Baseline blood pressure and heart rate of each subject was recorded without any stimulus. Then subjects were exposed to slow-beat music and blood pressure and heart rate were recorded. After15 minute break, and a little cognitive task for distraction, subjects were exposed to fast-beat music and blood pressure and heart rate were recorded again. Results: Multivariate analysis of covariance (MANCOVA) test showed that extravert patient subjects obtained greater reduction in systolic blood pressure and heart rate after presenting slow-beat music compared with introvert patients (P= 0.035, and P= 0.033 respectively). And extravert healthy subjects obtained greater reduction in heart rate after presenting slow-beat music compared with introvert healthy subjects (P= 0.036). However, there are no significant differences between introvert and extravert groups in systolic and diastolic blood pressure and heart rate after presenting fast-beat music. Conclusion: Based on our results, introvert subjects experience negative emotions more than extravert subjects and negative emotions cause less change in blood pressure in these subjects compared with extravert subjects.

Safety and efficacy of caproamin fides and tranexamic Acid versus placebo in patients undergoing coronary artery revascularization

Abstract: Introduction: Excessive fibrinolysis contributes to post-cardiopulmonary bypass bleeding. Tranexamic Acid (TXA) and Caproamin Fides are synthetic lysine analogues that inhibit plasminogen-fibrin binding. The present study aimed to compare TXA and Caproamin Fides versus placebo in patients undergoing elective coronary artery revascularization. Methods: We analyzed perioperative data of 300 adult patients undergoing coronary artery revascularization. Patients were randomly allocated to receive TXA (n=100), Caproamin Fides (n=100) or placebo (n=100) during perioperative time. Mediastinal bleeding during the first 24 hours post-operation, transfusion requirement and post-surgical complications were assessed. Results: Most descriptive and intra-operative parameters were well comparable between the 3 study groups. Except for mean number of packed red blood cell (PRBC) units transfused during ICU stay (P=0.01), patients in the Caproamin Fides and TXA groups did not show any statistically significant differences regarding transfusion of blood products during peri-operative period. There was no evidence of a significant difference in mediastinal blood loss during the first 24 hours post-operation between the patients receiving TXA or placebo, while patients in the Caproamin Fides group had significantly lower mediastinal bleeding than the other 2 groups (Caproamin Fides vs. placebo, P=0.002, 0.05). Conclusion: In conclusion, Caproamin Fides seems to be superior to TXA regarding the blood saving effects in patients undergoing coronary artery revascularization.

Percutaneous Dilatational Tracheostomy and Surgically Created Thracheostomy in ICU Patients

Abstract: Introduction: Following advances of Intensive Care medicine and widespread administration of mechanical ventilation, tracheostomy has become one of the indispensable surgical procedures. During this research we tried to assess and compare two main strategies for doing tracheostomy: Surgically Created Tracheostomy (SCT) and Percutaneous Dilatational Tracheostomy (PDT).Methods: In a randomized clinical trial, 60 cases of patients who were admitted in Intensive Care Unit (ICU) and needed tracheostomy during their stay were enrolled. Patients were randomly divided into two groups. SCT technique was considered for the first group and PDT for the second one. Demographic characteristics, associated and underlying diseases, type and duration of procedure, duration of receiving mechanical ventilation and ICU stay, expenses and complications of tracheostomy including bleeding, subcutaneous emphysema, pneumothorax, stomal infection and airway loss were all recorded during study and compared between both groups.Results: There were significant differences between two groups of patients in terms of duration of receiving mechanical ventilation (P=0.04), duration of tracheostomy procedure (P=0.001) and procedure expenses (P=0.04). There was no significant difference between two groups in terms of age and gender of patients, duration of ICU stay and complications of tracheostomy including copious bleeding, stomal infection, subcutaneous emphysema and airway.Conclusion: According to the results of our study and similar researches, it can be concluded that PDT can be considered as the preferred procedure in cautiously selected patients during their ICU stay.

Variations of QRS Morphology in Patients with Dilated Cardiomyopathy; Clinical and Prognostic Implications.

Abstract: The QRS represents the simultaneous activation of the right and left ventricles, although most of the QRS waveform is derived from the larger left ventricular musculature. Although normal QRS duration is <100 millisecond (ms), its duration and shape are quite variable from patient to patient in idiopathic dilated cardiomyopathy (IDCM). Prolongation of QRS occurs in 14% to 47% of heart failure (HF) patients. Left bundle branch block (LBBB) is far more common than right bundle branch block (RBBB). Dyssynchronous left ventricular activation due to LBBB and other intraventricular conduction blocks provides the rationale for the use of cardiac resynchronization therapy with biventricular pacing in patients with IDCM. Fragmented QRS (fQRS) is a marker of depolarization abnormality and present in significant number of the patients with IDCM and narrow QRS complexes. It is associated with arrhythmic events and intraventricular dyssynchrony. The purpose of this manuscript is to present an overview on some clinical, echocardiographic and prognostic implications of various QRS morphologies in patients with IDCM.

Anomalous origin of right coronary artery from distal left circumflex artery: a case study and a review of its clinical significance.

Abstract: Single coronary arteries are rare congenital anomalies in which the whole heart circulation is supplied by a coronary artery arising from a single ostium. Single left coronary artery with right coronary artery (RCA) originating from distal left circumflex artery (LCX) is a very rare anomaly with only few cases reported in the literature. We report a 44 years old male presenting with anterior myocardial infarction who was found to have a single left coronary artery during angiography. RCA had an abnormal origin arising from distal of a dominant LCX that retrogradely followed the course of a normal RCA to the base of the heart. A brief review of the reported cases with emphasis on the clinical significance of this unusual anomaly is presented.

Diagnostic Values of Plasma, Fresh and Frozen Urine NT-proBNP in Heart Failure Patients.

Abstract: Introduction: The plasma N-terminal probrain natriuretic peptide (NT-proBNP) level is animportant diagnostic and prognostic marker of heart failure. Recent studies have suggestedurinary NT-proBNP as a new and simple test for diagnosis of heart failure. We aim to comparediagnostic value of plasma, fresh and frozen urine levels of N-terminal probrain natriureticpeptide (NT-proBNP) for detecting heart failure.Methods: Between January 2010 and January 2012, we measured urine and plasma levels of NTproBNPin 98 patients with chronic heart failure (CHF) and 29 age- and sex-matched healthycontrol subjects.Results: There were significant correlations between plasma NT-proBNP and fresh (r=0.45,p<0.001) and frozen (r=0.42, p<0.001) urine NT-proBNP concentrations in CHF patients. Due toreceiver operating curve analysis, fresh and frozen urine NT-proBNP could diagnose HF with areaunder curve (AUC) of 0.73±0.04 (p<0.001) and 0.65±0.05 (p=0.01) with sensitivity and specificityof 73.97%, 58.62%, and 65.31%, 62.07%, for a cut-off of 94.2 and 96 pg/mL, respectively. PlasmaNT-proBNP had greater AUC (0.94±0.02, p<0.001) and better sensitivity and specificity (94.9%,89.66% for cut-off of 414.5 pg/mL). There was no significant correlation between LVEF andplasma, fresh and frozen urine NT-proBNP levels in CHF patients.Conclusion: Plasma NT-proBNP is still the best diagnostic marker with high sensitivity andspecificity; however, urinary especially fresh urine NT-proBNP may be a surrogate to plasma NTproBNPfor diagnosing HF with acceptable accuracy.

Haemostatic Role of TachoSil Surgical Patch in Cardiac Surgery.

Abstract: Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria) is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients) or wait and see method (9 cases), were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20) of the surgeries were redo surgeries versus 100% (22/22) in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03).Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01), however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67).Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

Cost-effectiveness of cardiac biomarkers as screening test in acute chest pain.

Abstract: Introduction: Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Associated findings of electrocardiograph (ECG) are rather heterogeneous, and traditional cardiac biomarkers such as Creatine Kinase-MB (CK-MB) suffer from low cardiac specificity and sensitivity. In this study cost effectiveness of cardiac biomarkers single quantitative measurement was examined.Methods: The present descriptive-analytic study conducted on patients who were asked for troponin I and CK-MB. All patients who referred to Emergency unit of Tabriz Imam Reza educational-medical center during January 2012 to July the 2013 were included in study. All patients included in the study were documented in terms of age, sex, working shift of referring, main complaint of patient, symptoms in referring, ECG findings, and results of troponin I and CK-MB tests.Results: In this study, 2900 patients were studied including 1440 (49.7%) males and 1460 (50.3%) females. Mean age of patients was 62.91 (SD=14.36). Of all patients 1880 (64.8%) of patients referred during 8 a.m. to 8 p.m. and 1020 (35.2%) patients were referred during 8 p.m. to 8 a.m. The sensitivity of cardiac biomarkers’ test in diagnosing Acute Coronary Syndrome (ACS) disease was calculated as 44.8% and its specificity was 86.6%. For diagnosing Acute Myocardial Infarction (AMI), sensitivity of cardiac biomarkers’ test was 72.2% and its specificity was 86%. None of patients who were finally underwent unstable angina diagnosis showed increase in cardiac enzymes.Conclusion: In conclusion, cardiac biomarkers can be used for screening acute chest pains, also cost effectiveness of cardiac biomarkers, appropriate specificity and sensitivity can guarantee their usefulness in emergency room.

Changes in Serum NT-Pro BNP and Left Atrial BNP Levels after Percutaneous Transvenous Mitral Commissurotomy in Sinus Rhythm Versus Atrial Firilation.

Abstract: Introduction: Natriuretic peptides are secreted from the heart in response to increased wall stress. Their levels are expected to be increased in patients with mitral stenosis (MS) due tohigh left atrium (LA) pressure and pulmonary artery pressure (PAP). Percutaneous transvenousmitral commissurotomy (PTMC) if successful is pursued by a rapid decrease in LA pressure andsubsequent decrease in pulmonary artery pressure. The concurrent changes in natriuretic peptidelevels could be affected with heart rhythm.Methods: Forty five patients with severe rheumatic MS undergoing PTMC were enrolled. Weevaluated the serum NT-Pro BNP levels before and 24 hours after PTMC. BNP levels were alsomeasured from the blood samples obtained from LA before and 20 minutes after the procedure.Changes in biomarkers were assessed based on heart rhythm and success of the procedure.Results: While serum NT-Pro BNP levels showed significant decrease 24 hours after theprocedure (P= 0.04), BNP levels taken 20 minutes after PTMC from LA were similar to theirbaseline concentrations (P= 0.26). NT-Pro BNP levels decreased 51.7±182.86 pg/ml for SR and123.4±520 pg/ml for AF (P= 0.68).Conclusion: Immediate changes in BNP levels did not predict the success of procedure probablydue to the additional balloon inflation attempts in LA in several patients and half-life of BNP. BNPlevels obtained later may be of more value considering the half-life of this marker. Heart rhythmwas not found to influence the changes in biomarker levels. BNP and NT-pro BNP changes werenot found to predict success of the procedure.

Procedural Outcome and One Year Follow up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A Single Center Study.

Abstract: Introduction: Coarctation of aorta is the fourth most common cardiac lesion requiringintervention. While surgery used to be the only treatment option, endovascular intervention isnow considered the first option in simple coarctation lesions. Despite increased popularity, thereare currently no FDA approved stents for use in coarctation of aorta and data on the outcome ofthis procedure is still sparse.Methods: Between October 2004 and June 2010, 33 patients who underwent treatment withCheatham-Platinum stents for coarctation of aorta were retrospectively studied. All the patientsunderwent control CT scans at 6 month and echocardiography at 1 year follow-up.Results: There were 17 females and 16 males with a mean age of 26.64 ± 16.30 years (range 2-71years). The mean stent length and balloon diameter were 3.18 ± 0.56 mm and 15.7 ± 3.12 mmrespectively. We achieved an immediate success rate of 96.9% with the only complication of aorticrupture which led to our single mortality in this series. At 6 month follow up no complicationswere noted in the CT scans. The mean echocardiographic aortic arch gradient at one year followup was 21.73 ± 11.06 mmHg.Conclusion: This study is one of the few cohorts of patients with stenting for coarctation ofaorta in Iranian population which comprised a diverse group of patients from early childhoodto elderly. It was demonstrated in this study that stenting for coarctation of aorta is a safe andeffective procedure if done carefully and performed in selected patients.